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I believe this to be the definitive book on back pain. My own back popped again yesterday morning so now is 100% the right time for me to be reviewing and writing up this book.
There is another famous book that basically says back pain is all in the mind, or begins in the mind, but I am not sure I agree with it anymore, although there is some merit to it being a PART of the cause. I will come to that book at another time.
The original McKenzie range of rolls complement the exercises in the books, assist in postural management and alleviate pain. You may refer to the website OPTP.com for further information.
The centralization phenomenon : We now know that when pain moves towards the centre of the spine, the chances of improvement with the methods described in this book are very good. More on this later.
Chapter 1 : The Low Back or Lumbar Spine
Typical patients worsen their problems when bending forward for prolonged periods, and especially if sitting for prolonged periods such as when driving. It may be difficult for you to rise from a sitting position and it may take a few minutes before you are able to stand upright properly! True!
Activities such as gardening and vacuuming or any task that requires you to bend forward for a while cause you pain or , if it is already present, make it worse.
Myths about acute back pain
(1) Acute back pain is short-term pain. The fact that 50% of people with back pain experience recurring attacks or have chronic problems negates this myth.
(2) Spinal manipulation is the best and most effective treatment for back pain. We must do both exercises and activity, for together they allow patients to manage their own problem without clinicians.
(3) Ultrasounds treatment or electrical therapy assist recovery from back pain. Not so!
(4) Back pain is caused by inflammation. Sudden onset acute back pain is usually entirely mechanical in nature - a sprain of the supporting ligaments around the vertebrae in the lower back is the usual culprit.
(5) Back pain is caused by arthritis. Not true.
(6) You should take it easy and avoid vigorous activity. This advice may be necessary for one or two days after the onset of acute pain, but otherwise it is best to regain your mobility as soon as pain permits. The methods described in this book are designed to shorten the recovery process and will, if performed properly, reduce your chances of severe recurrence. The secret is to commence the recommended programme at the first sign of trouble.
(7) You will have to stop jogging and playing sports. This is untrue and harmful advice! Few back problems are serious enough to justify this statement.
(8) Back pain is caused by damp conditions or the weather or sitting in a draught. Climate and weather have often been accused of causing back and joint pains. It's not true, unless your pain is caused by prostatitis or other bladder control issues. Sitting in a draught has often been blamed for the onset of back pain, but more often it is the sitting posture of the individual that is responsible. None of these events are a cause of joint or back pain!
Chapter 2 : Understanding the Spine
It is the low back or lumbar and sacral regions that concern us most in this book.
The hollow in the lower back is called the Lumbar Lordosis.
When standing upright the lordosis is naturally present, although it varies from person to person. The lordosis is lost whenever the lower back is rounded as occurs during sitting and bending forward. If the lordosis is lost often and for long enough periods, then lower back problems may develop. The ligaments become fatigued or overstretched and may give way, resulting in another painful back episode.
Try bending one of your fingers until you feel strain and pain. If you don't listen to the pain message and keep the finger like this, the ligaments will eventually tear. Healing may take several days, but would be prolonged if every day you were to continue to apply the same strains to the finger.
The same things happen when you overstretch the ligaments in your back.
Pain arising from prolonged stretching is called the Postural Syndrome. Pain produced by overstretching in this manner is common and arises particularly when we develop poor postural habits. Whenever we remain in a relaxed position, whether standing, sitting or lying, prolonged stretching can easily occur.
Lifting excessive weights is also likely to cause overstretching and damage to the supporting ligaments of the spinal joints.
These types of injury cannot easily be avoided as they occur unexpectedly.
IMPORTANT : Unless appropriate exercises are performed to restore normal flexibility, the healed tissue may produce a continuous source of back pain and/or stiffness for years. Even though the original damage is repaired, the scar itself restricts movement and causes pain when stretched. Pain caused by stretching scar tissue is called the Dysfunction Syndrome.
Chapter 3 : Common Causes of Lower Back Pain
When you look at the photos on pages 36-37 of the book (slumping, bending, lifting, ironing), you will see that the lower back is rounded and the lordosis has disappeared.
Unfortunately many of us spend much of our work and leisure time with the lower back in a flexed rounded position and lose the lordosis. On the other hand, we seldom or never increase it to its maximum.
The effects of poor posture in the long term can be just as severe and harmful as the effects of injury.
The bent, stooped posture considered by many to be one of the inevitable consequences of aging (think of Aunty Susan) is not at all inevitable. and the time to commence preventative action is now! If you stand fully erect and bend fully backward once a day, you need never lose the ability to perform that action and therefore need never become bent, stopped and impaired in any way.
SITTING:
Most people sitting for prolonged periods eventually adopt a slouched posture. When next you go to a restaurant or to the movies, look at the posture of those around you. You will see that most people have allowed their backs to slouch and become rounded.
You may experience discomfort in the lower back when attempting to arise from sitting. The pain is usually short-lived at this stage. Later in life, you find that on attempting to stand you have increased pain and must walk carefully for a short distance before you can straighten up fully. That's me!
Poor sitting posture is by far the most common postural fault and can easily be fixed if you want to.
You must no longer sit in the old way! From now on always pay attention to your sitting posture. Keep a lordosis.
Forming a lordosis using the slouch-overcorrect procedure:
Be careful to restore the lordosis slowly and with caution, never quickly or with a sudden movement.
Sit on a stool or sideways on a dining chair. Allow yourself to slouch completely. Now you are ready to commence the slouch over-correct procedure:
(1) Relax for a few seconds in the slouched position, then draw yourself up and accentuate the lordosis as far as possible. This is the extreme of the correct sitting position.
(2) Hold yourself in this position for a few seconds, and then return to a normal correct position.
You should also perform this exercise whenever pain arises from sitting poorly. Each time you repeat, make the over-correction to the maximum possible degree.
Maintenance of the Lordosis:
It is not possible to sit in extreme good posture for long periods as it can cause strain and even pain. To sit comfortably and correctly, sit just short of the extreme good posture.
To get to the correct position, go to extreme lordosis and then release the last 10% of the strain. This position can be maintained for any length of time.
Whenever you sit in a seat without a backrest, ensure you sit in this way. If you become uncomfortable, change position for a few minutes and then go again.
The Lumbar Roll : As few seats or chairs provide correct support for the lower back, I have found it necessary to use a lumbar roll in the car, sofa and at the dining table.
Today, a lot of chairs have some degree of lumbar support, but few go the necessary lengths and it is still preferable to use a lumbar roll.
The goal is to be completely pain free even when you sometimes forget correct sitting posture. However, you should never again allow yourself to sit slouched for long periods.
In order to minimise the risks associated with prolonged sitting, such as a long car journey, it is necessary to use a lumbar roll and interrupt sitting at regular intervals and before pain starts. If driving, stop the car every hour, get out and bend backwards five or six times and then walk around for a few minutes.
This reduces the pressure within the discs and relieves the stresses on the surrounding tissues.
As most airlines continue to provide poor seating, it is advisable to, when flying long distance, use a small cushion or inflatable lumbar roll. You should also regularly stand up and walk up and down the aisle.
This is not only important for your back, but will assist in the stimulation of the circulation in the legs.
STANDING:
When we are standing the lordosis is naturally present, but in some individuals, when the standing posture is maintained for a long time, the lordosis can become excessive and pain produced is of a different nature than that occurring during prolonged bending.
You may have already found that your back pain appears only if you stand for long periods or only after you get into bed. Pain that behaves in this way is frequently caused by poor posture alone. If this is the case, it is easily rectified, by correcting your standing posture.
Correction of Standing Posture : To stand correctly, you must hold your lower back in a position of reduced lordosis. To find this position, first stand relaxed. Allow the chest to sag and the abdomen to protrude slightly; this places the lower lumbar joints in extreme lordosis. Now reduce the lordosis by standing as tall as you can. Lift the chest up, pull in your stomach muscles, and tighten your buttocks. You have now reached the correct standing posture. In this standing position you reduce the lordosis with your own muscular effort. To begin with it is difficult to effectively hold this position, but with practice this new position can be held for long periods without discomfort.
Working in Stooped Positions : Many activities around the home may cause you to bend - for example, gardening, sweeping, diffing, vacuuming, making the bed, etc. While working in these bent positions, you are more likely to sustain back problems in the morning, before you are warmed up. In order to minimise the risks involved in prolonged forward bending the stooped position should be interrupted at regular intervals before pain starts. Stand upright and bend backward five or six times. When this is done before pain starts, it usually prevents the development of low back pain; and remember, because the discs in your spine swell up naturally during your non-weight-bearing hours, you are at risk in the earlier hours of the day, so make sure you do everything correctly in this period.
Lifting : Incorrect lifting technique while lifting heavier objects may cause sudden severe pain. Stand upright and bed backward five times before and after lifting. This is even more essential if you have been sitting for a while before lifting.
After driving for a long time, suddenly lifting a heavy suitcase out of the boot is a high risk situation. Again, bend backward five times before lifting and you reduce the likelihood of any damage.
Correct lifting technique : Throughout lifting, you must attempt to retain the hollow in your low back. The lift should be applied by straightening the legs. This is the correct lifting technique:
(1) Stand close to the load, have firm footing and a wide stance.
(2) Accentuate the lordosis.
(3) Bend your knees to go down to the load and keep your back straight.
(4) Get a secure grip and hold the load as close to you as possible.
(5) Lean back to stay in balance and lift the load by straightening the knees.
(6) Lift steadily; do not jerk.
(7) When upright, shift your feet to turn and avoid twisting the low back.
(8) The same technique should be used in reverse when lowering the heavy load.
Do not sit down or slouch after intense physical exercise! You must sit correctly with support. Thoroughly exercised joints of the spin distort easily if they are subsequently placed in a slouched position.
Correction of sleeping surface : There are two simple ways in which you may be able to reduce strains on your low back caused by a faulty lying position. The first and most important way is to lie with a supportive lumbar roll around your waist. The roll supports your low back as you rest and prevents strain that can develop when you lie on your side or back.
Sleeping with a Night Roll may initially be uncomfortable, but this should pass within a few days.
Many people with back problems are told never to lie face down when in bed. There is no evidence whatsoever to suggest that this is harmful to the back. On the contrary, it may well be that your back ceases to be painful in the face-down position. If you have not already discovered the effects of lying dace down, I suggest that you experiment to see what effect this has on your problem the next time you experience pain while lying. Certainly there are some lower back problems that are aggravated by lying in this way. If you have severe sciatica, lying face down is actually nearly impossible!
A soft mattress (or topper) can be extremely comfortable provided it is placed on a firm support. A study reported that patents who slept on the medium-firm mattresses were more likely to report reduced back pain in bed, reduced back pain upon rising from the bed, and less back pain related to disability than the patients who slept on a firm mattress.
UNDERSTANDING THE McKENZIE METHOD
The aim of the exercises : The exercises in this book are not designed to strengthen the muscles of your back. They are designed to produce changes in the internal disk components in and around the spinal vertebra. In doing so, you will notice that there are simultaneous changes in the location or the intensity levels of your pain. The manner in which these changes occur allows you to diagnose your problem.
The exercises programme consists of seven exercises : the first four exercises are extension exercises (bending backward) and the last three are flexion exercises (bending forward).
STOP ANY OTHER EXERCISES THAT YOU MAY HAVE BEEN SHOWN ELSEWHERE.
Postural correction and maintenance of the correct posture should always follow the exercises. For the rest of your life, whether or not you have back pain, good postural habits are essential to prevent the recurrence of your problems. Good posture also gives the added bonus of making you look healthier and more confident.
Effect on pain intensity and location : There are four main effects to look for while performing the exercises.
(1) The first few movements may be painful but with repetition you will find that you are moving further and further before the pain is felt
(2) They ay cause the symptoms to disappear.
(3) They may causes an increase or decrease in the intensity of the pain that you experience.
(4) The may causes the pain to move from where you usually feel it to some other location.
It is important that you closely observe any changes in the intensity or location of your pain. Your pain usually localises or centralises. In almost all cases it will end up in the small of your back.
The effects of exercise on the intensity or location of pain can sometimes be very rapid. It is possible to reduce the intensity or change the location of pain after completing as few as ten or twelve movements, and in some conditions the pain can completely disappear.
Centralisation : The centralisation of pain is the most important guide you have in determining the correct exercises for your problem.
A few patients may not initially respond to extension exercises, in which case go to the No response or benefit section later on.
The key to success is to let yourself be guided by the exercises that centralise, reduce or abolish your pain.
THE EXERCISE PROGRAM
Exercises 1 Lying face down :
Lie face down with your arms beside your body and your head turned to one side. Stay in this position take a few deep breaths, and then relax completely for a few minutes. Make a conscious effort to remove all tension from the muscles in your low back, hips and legs. Without this complete relaxation, there is no chance of eliminating any distortion that may be present in the joint.
Start each session with this exercises, and repeat the lessons every two hours until you go to bed.
This exercises is used mainly in the treatment of acute back pain and is one of the first-aid exercises for emergency back pain.
Exercise 2 Lying face down in extension :
Place your elbows under your shoulders so that you can lean on your forearms (baby cobra). This exercise is used mainly in the treatment of severe low back pain and is one of the first-aid exercises too. This exercise always follows naturally from exercises 1 and is performed once per session ahead of exercise 3.
Exercises 3 Extension in Lying :
This is the full cobra position where you push up all the way with your arms and make them straight. Push the top half of your body up as far as the pain permits. Keep your pelvis, hips and legs limp and allow your low back to sag. Maintain this position for a second or two, then lower yourself completely.
Repeat this movement cycle in a smooth rhythmical motion and try to raise your upper body a little higher each time. Once your arms are straight, remember to hold the sag for a second or two as this is the most important part of the exercise. A more effective sag can be achieved by breathing all the way out while relaxing your low back, hips and legs. The sag may be held for longer if you feel the pain reducing.
This is the most useful and effective first-aid procedure in the treatment of acute low back pain. The exercises can also be used to treat stiffness of the low back and to prevent pain from recurring.
Never be satisfied that you have moved as far as possible. Say to yourself each time you pish up "further, further, further". Perform this exercise ten times.
Exercises 4 Extension in Standing :
Stand upright with your feet slightly apart, place your hands in the small of your back with the fingertips pointing backward so that they meet in the centre of your spine.
Bend backward as far as you can, keeping your knees straight. Maintain this position for a second or two, and then return to the starting position. Repeat the cycle, trying to bend backward a little further.
Once you have fully recovered and no longer have low back pain, this exercise is your main tool in the prevention of more low back problems. Whenever you find yourself working in a slouched or forward bend position, interrupt it regularly and perform this exercise as a preventative measure before pain appears.
Exercises 5 Flexion in Lying :
This exercise should be applied with caution as it could cause aggravation of your problem if commenced too soon.
Lie on your back with your knees bent and your feet flat on the floor. Bring both knees up to your chest. You know this exercise! Place both hands around your knees as close to the chest as pain permits. Breathing out as you bring your knees to your chest makes this exercise easier to perform and also makes it more effective.
Maintain this position for a second or two, then lower the legs and return to the starting position.
IT IS IMPORTANT THAT YOU DO NOT RAISE YOUR HEAD AS YOU PERFORM THIS EXERCISE OR STRAIGHTEN YOUR LEGS AS YOU LOWER THEM.
Repeat the cycle, each time trying to bring your knees closer to your chest
This exercise is used to restore flexibility to tissues that have become damaged since your injury or pain began. If you do not complete the exercise as described, the tissue may be at risk of tearing with any sudden forward bending. This goes for the next two exercises as well.
As you have probably realised, this exercise eliminates the lordosis once the knees are bent to the chest, so in order to rectify any distortion that may result, flexion exercises must always be followed by Exercise 3 or Exercise 4.
You may stop performing Exercise 5 when you can readily pull the knees to the chest without producing tightness of pain.
Exercises 6 Flexion in Sitting :
Sit on the edge of a steady chair with your knees and feet well apart.
Bend your trunk forward and touch the floor with your hands. Return immediately to the starting position.
Repeat this movement cycle rhythmically, and each time try to bend down a little further so that in the end you have reached the maximum possible degree of flexion and your head is as close as possible to the floor.
This exercise can be made more effective by holding onto your angles with your hands after you bend forward and pulling yourself down further.
Exercise 6 should only be begun after the completion of one week of practice of Exercise 5, whether that one has been successful or not.
Remember that flexion exercises must always be followed by Exercise 3 or Exercise 4.
Exercises 7 Flexion in Standing :
Bend forward at the waist and run your fingers as far down your legs as you can while keeping your legs straight. Return immediately to the standing position.
Repeat this cycle rhythmically, and try to bend down a little further each time so that in the end you have reached the maximum possible degree of flexion and your fingertips are as close as possible to the floor. Always return immediately to the upright standing position, do not remain bent forward.
Exercise 7 should only be commenced after the completion of two weeks of practice of Exercise 6, whether that one has been successful or not.
Remember that flexion exercises must always be followed by Exercise 3 or Exercise 4.
For a period of three months from the time you have become pain-free, Exercises 7 must never be performed in the first four hours of your day, during which time you are at more risk of recurrence.
When to apply the exercises: WHEN YOU FEEL GOOD, YOU, LIKE ALL OTHERS WITH THE SAME PROBLEM TEND TO FORGET THE PRECAUTIONS YOU SHOULD TAKE.
When you have significant back pain:
Pain from an acute episode of low back pain is usually felt at all times, regardless of the position adopted or the movements being performed. With few exceptions, it is made much worse by sitting, rising from sitting, and by bending forward.
If the pain is also much worse on attempting to stand or walk and if you are unable to straighten up fully, it may not be possible for you to function and bed rest may be the only choice.
Research tells us that bed rest is not the best option for the treatment of acute and severe back pain and should be given for no more than two days.
WHEN TO START EXERCISING:
Seek advice from your doctor if the pain is so bad that you cannot perform any of the exercises. You made need Aspirin or Ibuprofen to give you some respite. Remember that if your pain does not improve with the exercises go and read the 'No response or Benefit' section later on.
You may start the exercises during your brief period of bed rest provided you can lie face down. Perform Exercises 1, 2 and 3. These exercises are first-aid for low back pain.
As soon as you feel considerably better, no longer have constant pain and are walking again -perhaps a day or two after you have commenced exercising - you may stop Exercises 1 and 2, but you should continue Exercise 3 and add Exercise 4 : Extension in standing.
When acute pain has subsided:
The risks of further damage are much less now for the exercises where you round your back in the lying position. There you must now perform Exercise 5 : Flexion in Lying.
Exercise 5 should begin when you have recovered from an acute period of low back pain and have been pain-free for two to three days. You can also use Exercise 5 if, two weeks after the incident, you still experience a small amount of pain in the centre of the back that does not seem to disappear.
It is not uncommon for some central and low back pain to be produced when starting with flexion in lying. An initial pain that wears off gradually with repetition of the exercise is acceptable; it means that shortened structures are being stretched effectively. However, if flexion in lying produces pain that increases with each repetition, you should stop. In this case it is either too soon to start flexion or the exercise is not suitable for your condition.
When you can touch your chest with your knees easily, and without discomfort, you have regained full movement. You may now STOP exercise 5 and begin Exercises 6 : Flexion in Sitting. After two to three weeks, Exercise 6 should cause no tightness or discomfort and once you have reached this point you mad add Exercises 7 : Flexion in Standing.
Carry out Exercise 7 at the end of the day once or twice a week to ensure that all the soft tissues in the back remain extensible. After completing Exercises 6 and 7 follow the guidelines to prevent recurrence of low back problems written below.
TO PREVENT RECURRENCE OF LOW BACK PROBLEMS:
(1) Perform Exercise 3 : Extension in Lying on a regular basis, preferably morning and evening.
(2) Perform Exercise 4 : Extension in Standing regularly whenever you are required to sit or bend forward for long periods. I recommend that you also do this exercise before and after heavy lifting, and as soon as you feel minor strain developing in your low back.
(3) Practice the slouch-overcorrect procedure whenever you are becoming negligent about the correct sitting posture.
(4) Perform Exercise 7 : Flexion in Standing once or twice a week to remain fully flexible.
(5) Always use a suitable lumbar roll in chairs that do not provide adequate support.
It is advisable to exercise in the manner described above for the rest of your life, but it is a necessity that you develop and maintain good postural habits.
NO RESPONSE OR BENEFIT:
Check list:
(1) Did you feel better for a while after exercising only to find the pain returned later? If that is the case, you have probably missed some of the detailed advice.
(2) Did you push yourself as far as possible, 'sagging' in the middle, when you applied Exercise 3?
(3) Did you say to yourself, 'Further, further, further' each time?
(4) Did you perform ten movements each time?
(5) Did you perform the exercises six to eight times per day?
(6) Did you stop all the other exercise you may have been in the habit of doing?
(7) Did you bend over too far or for too long after exercising?
(8) Did you catch yourself sitting badly or without a lumbar roll at any time?
(9) Does your pain change its position and appear to move around? If so, you should follow the next section carefully.
If you are quite certain you have followed all the requirements listed above and are not improving, there are several more steps you can take that may abolish, reduce or centralise your symptoms.
The first step is to increase the pressure on your back as you perform Exercises 2 and 3. The force you can apply yourself may be insufficient.
The effectiveness of Exercise 3 can be improved by having another person apply pressure to your low back. The pressure should be applied just or slightly above the level of your pain. The intention is for you to press up as in Exercises 3 while your helper is applying the pressure to hold you down. This has the effect f accentuating the hollow in your back. It is vital that you allow your back to sag as this is proceeding. Repeat this six or seven times.
The pressure applied by your helper should never causes severe pain that you cannot tolerate, or severely increase your pain.
If you do not have a helper available, you could construct a simple device using a flat board with a strong strap held firmly around the waistline.
The second step is important if your pain is felt more to one side or if it radiates into your buttock or leg. This happened to me once! If your pain during the course of the day is felt only to one side, more to one side than the other, or if you feel pain more to one side as you perform Exercises 1, 2, or 3, you may need to modify your body position before commencing them.
To achieve this modification: Adopt the position to perform Exercise 1 and relax. Remain face down and move your hips 3 inches away from the more painful side and relax here for a few minutes.
Allowing the hops to remain off-centre perform Exercise 2 for three minutes and then move on to Exercise 3. It is more difficult to push up when off-centre but keep trying to move higher and higher when repeating the cycle. Keep your arms as straight as possible. See pages 92-93.
Keep doing this modification daily until the pain has centralised and then start at the beginning with Exercises 1 performed in the original manner.
The next two exericses are alternatives to the previous modification for those who are unable to lie down.
Slide Glide in Door Frame
(1) With correct standing posture, stand in the middle of a doorway with your feet about shoulder-width apart.
(2) Place the palms of your hands and forearms vertically against either side of the door frame.
(3) Using your arms against the doorframe to stabilise your upper body, move your pelvis and hips away from the side of the pain (Page 95).
(4) Make sure you have gone as far as is tolerable then return your hips to the starting position.
Slide Glide against the Wall
(1) Place your feet together at least 30 centimetres from the wall. Hold your arms with elbow bent at right angles between your rib cage and the wall. Check pages 96-97.
(2) Lean your pain free side against the wall.
(3) Keep your shoulder and upper body against the wall and slide your pelvis towards the wall using the other hand to add more pressure.
(4) Keeping the upper body against the wall, release the hand pressure and allow the pelvis to move away from the wall.
(5) Repeat the cycle 10 times with each movement moving the pelvis further and further.
Always remember that if your pain is moving away from the centre of your back or radiating further into your buttock and leg, you are moving in the wrong direction. Any exercise that is causing this should be stopped as soon as you are aware of the increasing intensity or spread of pain.
Once the pain has moved to and remains in the centre of your back, return to Exercises 3 and 4.
Recurrence:
Irrespective of what you are doing or where you are, at the first sign of recurrence of low back pain you should immediately start the exercises that previously led to recovery and follow the instructions give to relieve acute pain. Commence Exercise 4: Extension in standing. If this does not abolish your pain within minutes, you must quickly introduce Exercise 3: Extension in lying. The immediate performance of Exercise 3 can often prevent the onset of a disabling attack. If your pain is already too severe to tolerate these exercises, you should commence with Exercises 1 and 2.
When Acute Low Back Pain Strikes:
Immediately being the self-treatment exercises.
Sit as little as possible and for short periods only.
(1) If you must sit, choose a firm chair with a straight back, make sure that you have an adequate lordosis.
(2) Use a lumbar roll to support the low back.
(3) Avoid sitting on a low, soft couch.
(4) Avoid sitting with your legs straight out in front as in sitting up in bed or in the bath or on the sofa with your legs on the coffee table; these positions force you to lose the lordosis.
Many activities, such as vacuuming, brushing teeth, washing hands, washing dishes, sweeping the floor etc will place you at risk. Avoid them at this crucial time. You should not lift any weight at all.
Be careful to restore the lordosis slowly and with caution, never quickly or with jerky movements. You need to allow some time for the distorted joint to regain its normal shape and position: a sudden or violent movement may retard this process, increase the strain in and around the affected joint, and thus result in an increase of low back pain.
To stand up from lying, lie on your side on the edge of the bed, making sure your lordosis is present. Pull your knees up so your thighs are at right angles to your upper body, drop your feet over the edge of the bed and rise into the sitting position using your hands to push you up - all the time sitting tall and maintaining your lordosis. Take care not to lean forward as you transfer your weight from the bed to the floor.
Avoid coughing and sneezing while sitting or bending forward. If you feel a cough or a sneeze coming on, stand up immediately and bend backwards, placing your hands in your low back for support.
Low back pain in Pregnancy: After the child is born the mother is often too busy to care for herself properly, and sometimes the postural fault that has developed during pregnancy remains present for the rest of her life.
Mothers should concentrate on correct standing posture. Walk tall, stand tall and do not slouch.
Low back pain in Athletes: A common mistake is when someone gets low back pain and a physio believes it is due to the sport they participated in. However, the cause of the pain is frequently the adoption of a slouched position following the thorough exercising of their joints. After exertion we usually sit down and relax.
Poor posture is often seen in athletes during intervals of nonparticipation, such as waiting to take the field in soccer or rugby or cricket.
From now on, immediately after activity, consider your posture carefully and sit correctly with the low back in moderate lordosis supported by a lumbar roll. Maintain the correct posture meticulously.
If your pain continues to appear after activity in spite of correcting your posture, it is possible that you have weakened or damaged some of the soft tissues in your low back. So no you should perform Exercises 3 and 4: Extension in lying and Extension in standing on a regular basis.
Low back pain in the over 50's:
If you are over 55 you may notice that you experience a more persistent che in the low back, but without the acute episodes of the past.
It is now known that acute low back pain tends to occur less frequently when we pass this age! I have found that age is not necessarily a barrier to the successful application of the exercises.
Nevertheless, this aching can cause significant problem, especially if you are forced to reduce activity. The human body thrives on activity and decays with prolonged in activity.
It isn't true that you have to live with discomfort when you are older. Even people with age-worn joints have never had back pain and we know that this wearing, in itself, is not a cause of pain.
It is undesirable for any of us, irrespective of age, to reduce our levels of activity. Only if reduced activity is forced upon us by significant health problem should we exercise less.
Osteoporosis:
From middle-age women are affected by a disorder called osteoporosis, which is essentially a mineral deficiency disorder. During and after the menopause, there is a significant and continuing deficiency in calcium replacement that must often be supplemented with calcium on a regular basis. As a consequence of calcium deficiency there is a weakening of bone structure, resulting in a slow but progressive reduction in height. This allows posture to become extremely rounded, especially in the middle or thoracic part of the spine.
This suggests that women from perhaps the age of 40 onwards should practice the extension exercises as described, on a regular basis.
My own recommendation would be repetitions of exercises 1-3, 15 to 20 times, four or five times per week.
Common Remedies:
Medication : There are NO drugs capable of removing the causes of common backaches or pains; therefore, medication should only be used when pain is severe.
Bed rest : When your back pain is so severe that bed rest is required, this period of rest should be no more than two or three days.
Acupuncture : It may be used if all else has failed but it will not correct any underlying mechanical problems.
Emergency Panic Section:
In case of sudden onset of acute pain, carry out the following instructions:
(1) Immediately lie face down. If this is impossible because of pain intensity, go to bed.
(2) If necessary stay in bed for two or three days maximum, correctly supported.
(3) Use a rolled towel or Night Roll around your waist when resting in bed.
(4) Perform Exercises 1 and 2 once, and then Exercise 3 ten times. Repeat this sequence every two hours during the day.
(5) If the pain is more to one side and not reducing, move hips away from the painful side and do Exercises 2 and 3.
(6) Avoid all movements that aggravate symptoms.
(7) Do not slouch or bend forward AT ALL for three to four days.
(8) Use a small cushion or a lumbar roll for support when sitting.
(9) Maintain perfect posture at all times.
(10) Be particularly careful whilst watching TV or at the computer.
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